IS A HOSPITAL BIRTH WITH A MIDWIFE RIGHT FOR YOU?

The information on this page will help you think through whether a hospital birth with a midwife is the right choice for you. The more you learn about your options, the better you’ll feel about the choice you finally make. There’s a lot to consider, including the practical and emotional advantages and disadvantages of each setting, the scientific evidence on outcomes, how to find a provider, and what other options you have.

OVERVIEW

Midwives are experts in normal birth and offer personalized, holistic, family-centered care for low-risk women. If you choose a hospital-based midwife, you have the option of an epidural. The technology of the hospital is also right there if you need it. Midwives who work in hospitals may also be able to care for you even if you have some risk factors.  For many women, this combination of high-touch and high-tech feels like the best of both worlds.

There are many other practical and emotional advantages and disadvantages that you’ll also want to consider as you decide whether a hospital birth with a midwife is the right choice for you. (Scroll down to see Considerations.)

For low-risk women, hospital-based midwives have outcomes as good as those of doctors. If you choose a hospital-based midwife instead of a doctor, you are also less likely to have any interventions—including cesarean birth, induction, episiotomy, and pain medication. On the other hand, be aware that hospital-based midwives may have higher intervention rates than midwives who attend births at home or in a midwife-led birth center. (Scroll down to The Research Says to see a summary of the research. You can also go directly to a more in-depth discussion of the evidence by clicking here.)

Of course, not all hospitals are alike.  And not all hospital-based midwives are alike.  Once you decide that you prefer (or need) the care of a midwife in the hospital, take time to look around for a hospital and midwife practice that are a good fit for you. (Scroll down to read Choosing a Hospital and Choosing a Hospital-based Midwife.)

And if you decide a hospital birth with a midwife isn’t right for you, you have other good options. (Scroll down to read Alternatives to Consider.)

 

OTHER CONSIDERATIONS

Each birth setting has advantages and disadvantages. Different people will weigh those differently. You need to sort through what matters most to you. Here are some considerations that may help you decide whether hospital birth with a midwife is or isn’t right for you.

THE RESEARCH SAYS . . .

The safety of midwifery care in the hospital is supported by high-quality research evidence. That research consistently shows that midwives caring for low-risk women (and some women of moderate risk) have outcomes at least as good as those for doctors, and some intervention rates that are lower.

You can learn more about the research here.

CHOOSING A HOSPITAL-BASED MIDWIFE

Midwives are not all alike. Some avoid interventions unless absolutely necessary. Others use interventions more readily. Don’t make assumptions. Ask your midwife about her approach and the statistics for her practice.  You can also show her your birth plan and gauge her reaction.

Midwives who practice in the hospital generally work closely with doctors and may be able to care for you collaboratively even if you have some risk factors. Midwives also vary in the role they play in the hospital. At some hospitals, midwives practice with full autonomy. At other hospitals, midwives practice under the oversight of an OB and have much less autonomy.

Once you decide that you might be interested in having your baby in a hospital with a midwife, plan to meet with midwives at several different hospitals. You are looking for providers you trust. This is also a good way to test whether your choice holds up as you begin to learn more.

Here are some prompts you may find helpful before and after your appointments. Pick the ones that seem important to you.

 

General questions for your provider:

  • What kind of birth do you see the most often?
  • What part of your job do you enjoy the most? What are you best at?
  • What do you think makes pregnancy and birth safer?
  • How likely is it that you would be the one actually attending my birth, and who else might end up being there?
  • How would you handle the situation if you recommended something to me and I ended up choosing a different option?
  • What kind of prenatal testing do you require? Recommend?
  • What do you do if I go past my due date?
  • Will a tub be available and do you ever use it for labor? For birth?
  • What is your cesarean birth rate?
  • What can I expect to pay out of pocket?

Questions specific to hospital-based midwives:

  • In what circumstances would my care be transferred to a physician? Would you continue to care for me as well?
  • In what circumstances do you induce?
  • How many of your patients get pitocin augmentation?
  • Who can be with me during labor? How do you feel about doulas?
  • How do you support women who want to avoid an epidural? What other pain management options will be available to me?
  • How quickly can I get an epidural if I ask for one? Is there dedicated OB anesthesia?
  • How long can I labor before intervention is suggested? Before C-section is suggested?
  • Are you present for most of labor, or do you often divide your time between many patients?
  • When do you cut the cord?
  • It what circumstances would I be seperated from my baby?

Questions to ask yourself after an appointment:

  • Did you feel at ease?
  • Did you feel rushed?
  • Did you feel listened to?
  • Were your questions answered?
  • Did the provider ask your permission before touching you?
  • How did your partner feel?

It can take awhile to get to know and trust your provider. If after several months you start to have doubts, don’t hesitate to make a change.

You might also find it helpful to read “Midwife or Doctor?  Two leading practitioners help you choose” in the BirthGuide Blog.

ALTERNATIVES

If the midwifery model of care appeals to you but you’re not sure about being in the hospital, you could look at the option of having your baby in a midwife-led birth center. Or, if you think you’ll be more comfortable with a more medical model of care, you might want to consider having your baby with a doctor in the hospital.